I work as a Research Scholar at the Center for Health Policy and Inequalities Research at Duke University. I also am an Adjunct Scholar at American Enterprise Institute and Mercatus-Affiliated Senior Scholar. Having been trained in policy analysis at the Pardee RAND Graduate School, I have decades of experience in evidence-based health policy at the federal and state level, specializing in health services regulation and the social burden of illness. I've taught health policy and the politics of health care in the Terry Sanford Institute of Public Policy, the Duke School of Medicine and the Fuqua School of Business at Duke. My latest book is "American Health Economy Illustrated."

The author is a Forbes contributor. The opinions expressed are those of the writer.

Will Health Care Matter in this Election?

To run on Obamacare or not? That is this election’s question. Over the summer, “Meet the Press” moderator David Gregory suggested congressional candidates in tough districts and even the White House may deliberately avoid running on the healthcare law. Yet, some progressives poo-poo such claims—calling, instead, for candidates to embrace a “full-throated defense” of the Affordable Care Act (ACA).

These conflicting views raise the question: in light of the available evidence, is it reasonable to believe that ACA will be a net voter winner for the president?

Public opinion, however, has been remarkably impervious to the flood of information that has come out since the law’s passage in March 2010. RealClearPolitics.com tracked 128 different polls conducted since that date; and in only a single instance did those opposing repeal outnumber those in favor.[4] The site’s current average shows 50.2 percent in favor of repeal versus 41.2 percent who are opposed.

Across these disparate polls, those favoring repeal have never dropped below 40 percent and have been as high 63 percent; those opposed to repeal have never exceeded 48 percent and have been as low as 32 percent. Thus, with the exception of a single poll, the degree to which those favoring repeal have outnumbered opponents ranges from three to 31 percent.

Meanwhile, the importance of healthcare relative to other issues has also held steady among votes. Leading up to the 2010 election, roughly 4 in 10 voters said that healthcare or health care reform would be extremely important in determining their votes. In contrast, the dominant issue (cited by about 6 in 10 voters) was the economy or jobs. Nearly two years later, the most recent Washington Post/Kaiser Family Foundation poll found the cost of health care still ranks second only to the economy as the most important problem facing the country, 59 versus 44 percent respectively.[5] (And pollsters collected this data prior to the selection of Paul Ryan as Mitt Romney’s running mate.)

When asked about specific health issues, respondents in the same poll ranked Medicare as extremely or very important by a much higher percent (73 percent) than those who attach the equivalent level of importance to the 2010 health law.[6] The cost of healthcare, Medicaid, and providing health coverage to the uninsured likewise ranked somewhat higher than ACA itself. But as the fierce controversy over $716 billion in the law’s spending cuts to Medicare illustrates, most of these issues will be framed in the context of how well ACA addresses them compared to the plan(s) offered by Romney and Ryan.

It should be no surprise to learn there is a sharp partisan divide regarding the healthcare law. Rep. Pelosi’s hopes notwithstanding, the trends are not encouraging. The Kaiser tracking polls show that the percentage of Republicans who favor the law peaked at 24 percent in August 2011 and has declined to only eight percent currently. More importantly, among independents (who, after all, will be determining the election’s outcome), favorable views have declined by 15 percentage points since June 2008. Even among Democrats, favorable views peaked at 75 percent in September 2010 and now have declined to 64 percent. Perhaps of equal importance, as Kaiser puts it, “Republicans’ intense opposition outpaces Democrats’ enthusiastic support.”[7]

Advocates tout the fact that individual components of the law poll very well. Yet, the types of questions asked undercut the value of the results. More than 70 percent of respondents report liking “easy-to-understand plan summaries” of their health benefits, health insurance exchanges, and elimination of costs for preventive health services. But that’s like asking whether people would like it if someone else paid for oil changes for their car. The response presumably would be very different if they were asked whether it was a good idea to force auto insurers to pay for the cost of oil changes.[8]

The big unknown in the mind of current voters relates to Mitt Romney’s plan. More than 70 percent of voters report having a “basic understanding” of what President Obama would do on healthcare if he won the election, versus only 45 percent who understand Gov. Romney’s plans on the issue. In the context of that level of voter ignorance about policy details, it should not be surprising that 53 percent trust the president at least “somewhat” to make the right decisions about the future of the health law, versus 40 percent for Romney. And there is not even a consensus among the polls on the latter point. For example, the most recent Rasmussen poll of likely voters shows that on healthcare, voters trust Republicans slightly more than Democrats on the issues of health care (44 to 41 percent) and the economy (45 to 40 percent).

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“To run on Obamacare…” With your first sentence you lost credibility by failing to call the program by it’s correct name. I do not see a balancing negative label to the other party’s health care program.

I was curious though and didn’t want to make a false assumption by going by the article’s initial sentence. So I checked up on the quoted sources. Let’s look at the Rasmussen polling group:

“According to the Center for Public Integrity, Scott Rasmussen, Inc. received $45,500 from George W. Bush in 2004. The payments were for “Survey Research.” [Center for Public Integrity, accessed 1/15/10]

RNC Paid Rasmussen Nearly $100,000 for Polling. The RNC paid Rasmussen $95,500 between 2003 and 2004 for items listed as “survey,” “survey cost” and “voter data.” [Center for Public Integrity] Rasmussen Took a National Review-Sponsored Cruise With Karl Rove. In 2010, Rasmussen took a cruise with Karl Rove and other conservative pundits just after the November elections. The cruise was hosted by the National Review and went to a private island, the Bahamas and Cozumel, Mexico. [Journal Sentinel, 6/23/10]

For the record, “Democrats Embrace Once Pejorative ‘Obamacare’ Tag” http://www.nytimes.com/2012/08/04/health/policy/democrats-embrace-once-pejorative-obamacare-tag.html

As for unbiased sources, I have linked generously to polls conducted by Kaiser Family Foundation and Washington Post, which are hardly conservative organizations. My allusion to a Rasmussen poll was merely to point out that there is not a consensus among the polls about which party would do best on health care.

In light of the foregoing, your “analysis” of my post seems less than even-handed. Hmmmm….

You are correct that selecting either Marco Rubio or Jeb Bush would have enhanced Mr. Romney’s electoral prospects in Florida considerably more than choosing Paul Ryan: http://fivethirtyeight.blogs.nytimes.com/2012/08/08/how-romneys-pick-of-a-running-mate-could-sway-the-outcome/

You may recall that during the Reagan administration, the Greenspan commission made a series of recommendations designed to save Social Security and preserve it for future generations. http://www.ssa.gov/history/reports/gspan.html Paul Ryan’s proposals for SS and Medicare are similarly motivated and no more “dismantle” these programs than the Greenspan commission did (even though the commission assuredly changed SS as we back then knew it).

As an average American Citizen, there is , in my opinion no way to understand the political info. and the politicak secrets.

As for the Presidential election , we have no real choice and must again vote for thwhat appears to be the lesser of the two evils. I am certain we will all, in some way , get hurt by politics that is not revealed to the American voter.

I will cast my vote to Obama. Mitt & Ryan are surely not a choice, except for the very, very wealthy. lynn parker

The operative word in the Affordable Care Act is “affordable”. If it does indeed help reduce health insurance premiums, the the people will be happy. Otherwise, the Dems will have created a monster entitlement program to the benefit of insurance companies and politicians, who take their contributions.